Personal Information Form for Candidate for Boards and Commissions
Board or Commission
*
First Name
*
Middle
*
Last Name
*
Present Address
*
City
*
State
*
Zip Code
*
Telephone Number
Format: (000) 000-0000.
Email
*
example@example.com
City Resident
*
Yes
No
If yes, how long?
Occupation
Education Background
Are there any reasons you may have a conflict of interest if you were appointed to this Board or Commission?
Yes
No
If yes, please explain.
Is there any information (experience, community activities, organizations, etc.) that you think should be considered for your appointment to this Board or Commission?
Why do you desire to serve on this Board or Commission?
Briefly describe how you might benefit the community if you were selected to serve on this Board or Commission?
DATE
/
Month
/
Day
Year
Date
SIGNATURE
Submit
Should be Empty: